The study assessed the effects of a life skills-based health empowerment intervention on resilience among adolescents in Purulia, India using a Solomon four-group design. 742 adolescents were assigned to experimental and control groups. The experimental group received an intervention focusing on life skills and health topics. Resilience, internal health locus of control, and self-determination significantly improved in the experimental group compared to controls following the intervention. The intervention was particularly effective at increasing resilience among tribal adolescents.
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Solomon four group design
1. Effects of health empowerment intervention on
resilience of adolescents in a tribal area: A
study using the Solomon four-groups design
Presenter: Avantika Gupta
Moderator: Prof Brogen Singh Akoijam
Social Science & Medicine xxx (2017) 1e10
3. SOLOMON FOUR GROUP DESIGN
An experimental design that assesses the effect of having been pretested
on the magnitude of the treatment effect
Richard L. Solomon
6. RESILIENCE
Ability of a vulnerable individual to cope in the presence of an
adverse situation is labelled resilience
Exposure to significant
threat or adversity
Achievement of positive
adaptation despite
major assaults on the
developmental process
9. LIFE SKILLS
Are the abilities for adaptive and positive behaviour, that enable
individuals to deal effectively with the demands and challenges of
everyday life
12. Effects of health empowerment intervention on
resilience of adolescents in a tribal area: A
study using the Solomon four-groups design
(good title)
13. ABSTRACT
Rationale: Resilience prevents the emergence of stress-related mental health problems among adolescents. Adolescents in
tribal areas of India are more prone to develop such problems.
Objectives: The primary objective was to determine the effect of combined life skills-based health empowerment
intervention on the resilience of school-going adolescents in a tribal area. The secondary objectives were to determine the
effect of the intervention on internal health locus of control and self determination and to compare the effect of
intervention on resilience between non-tribal and tribal adolescents.
Methods: We conducted this quasi-experimental study using a Solomon four-group design among 742 adolescents in two
schools of Purulia, West Bengal, India. Students of the pretested group were examined for resilience using the Child
Youth Resilience Measurement scale. A life skills education-based health empowerment intervention was administered
among students of the experimental group. Post-test data on resilience, self-determination, internal health locus of control
and pathological behaviour was obtained 3 months after the completion of intervention. A multi-level general linear
mixed model was constructed to determine the effect of intervention on resilience.
Results: Resilience was less among tribal adolescents at baseline. The intervention significantly improved resilience
[βAdjusted = 11.19 (95% CI ¼ 10.55, 11.83], with a greater increase for tribal adolescents [βtribal-nontribal = 1.53 (95%
CI ¼ 0.03, 3.03)]. The intervention also significantly improved internal health locus of control (marginal mean increment
1.38 ± 0.05), self-determination (marginal mean increment 3.71 ± 0.09) and reduced pathological behaviour of the
adolescents.
Conclusion: Our study informed the current health policy that the existing life skills education-based programme should
be reviewed and modified to include generic life skills, and the life skills education-based programme should be coupled
with developmental interventions aimed at improving adult education and family climate for optimum effect on mental
health and health behaviour of adolescents.
(Structured and informative)
15. • Mental health problems are linked to the negative affect state and
unsuccessful coping in the presence of stress
• Indian adolescents residing in tribal areas are exposed to an even
greater risk of developing stress-related mental health problems
• They face greater adversity in life course and are deprived of even the
basic amenities
16. • Threats and stressors: poverty, violence, disaster and war
• Low stress resilience in adolescence is associated with greater risk of
receiving medications for depression and anxiety in middle age
• Empowerment has been shown as an effective method to increase
resilience
17. • Strength-based approaches focus on local capacity building by
attending to inherent resources or strengths of individuals, families,
groups or organizations ‘deploying personal strengths to aid recovery’
• Popular form of strength-based intervention is life skills education
• Success of LSE depends on the fidelity of implementation
18. • To inform the current health policy regarding the effect of a short-term
modified LSE-based empowerment intervention on the resilience of
school-going adolescents
(scientific background and rationale well explained)
19. • Primary:
To determine the effect of combined life skills-based health
empowerment intervention on the resilience of school-going
adolescents in a tribal area
OBJECTIVES
20. • Secondary:
To determine the effect of the intervention on internal health
locus of control and self determination
To compare the effect of intervention on resilience between non-
tribal and tribal adolescents
(SMART with good action verb)
22. Study design:
Quasi-experimental study using Solomon four-group design
Study duration:
2013 to 2015 (period of 24 months)
(appropriate to answer objective)
(study duration mentioned)
23. Study setting:
• Purulia district of West Bengal
• One-fifth of district’s population is tribal
• Majority are residents of rural areas
• Tribal Health Project was started in 10 blocks of the district in 2007
by the Department of Health & Family Welfare, Purulia
24. • Literacy rate in the district is substantially lower than the state
average, while infant and maternal mortality rates are high
(not well described)
27. Inclusion criteria:
• Students of grade VI-IX (who had completed primary education at
the time of baseline survey)
• Age of the students ranged from 11 to 17 years
28. Exclusion criteria:
• Those who had any acute or chronic illness that would preclude their
participation in the study
• Those who failed to attend the pre-test, intervention or post-test
• Those whose parents did not give consent
(eligibility criteria for participants mentioned)
29. Sample size:
• According to Child Youth Resilience Measurement scale (CYRM-28)
development manual, the mean total resilience score of complex-needs
youth was 103.85 with a SD of 20.18
Non-inferiority limit (d) 10% (i.e., M = 10.39)
Significance level (α) 5%
Power (1-β) 90%
30. • Sample size : 65 each for the experimental and control groups
• For two schools, pretesting for the resilience score at baseline revealed
ρ = 0.073
• Therefore, calculations target the total effective sample size at 738
(sample size calculation well explained)
31. Sampling method:
20 Community development blocks of Purulia district
Line listing of blocks with ≥ 2000 households and headed by ST person
15 community development blocks
2 blocks selected at random
32. High schools were line listed List of West
Bengal Council of
Higher Secondary
Education
One co-ed school was selected from each block
For ethical reasons, all students
of each school were included in the study population
(sampling method not well described)
33. Purulia District
15 CD Blocks
Random selection of 2
blocks
Balarampur
Block
Purulia I Block
3 Co-ed Gvt. Hr.
Sec schools
2 Gvt. Sponsored
Hr. Sec schools
34. 1 school selected
randomly
1 school selected
randomly
All students studying from class VI to IX eligible for study
School I
Total eligible participants: 674
Total students excluded: 153
Total participating students: 521
School II
Total eligible participants: 283
Total students excluded: 62
Total participating students: 221
35. Distribution of students according to plan of administration of
intervention
Intervention
given:
Section A (187)
Section B (194)
Intervention
not given:
Section C (140)
Intervention
not given:
Section A & B
(221)
Pretested
Section
A
Not
Pretested
Section B
Pretested
(67)
Not
Pretested
(73)
Pretested
Section B
(114)
Not
Pretested
Section A
(107)
Fig. 1. Selection of study population and allocation of groups into the trial
37. • Per capita monthly income
• Family climate related risk factors:
Violence among parents
Physical abuse on the adolescent by any family member
Substance abuse among parent
• Academic performance
38. • Primary outcome:
Assessment of individual resilience
• Secondary outcome:
Internal HLC
Self-determination
Screened for the presence of any pathological behaviour
Outcomes:
41. Secondary outcomes:
• Internal HLC
Internal domain of multidimensional
health locus of control scale A
• Self-determination Self Determination Scale
• Pathological behaviour Goodman's SDQ tool
All the questionnaires were culturally adapted, validated and pretestedCronbach’s α: 0.70 – 0.80
SELF DETERMINATION SCALE (SDS):
Items Subscale: Awareness of self
2
A. My emotions sometimes seem alien to me
B. My emotions always seem to belong to me
4
A. I feel that I am rarely myself
B. I feel like I am always completely myself
6.
A. When I accomplish something, I often feel it wasn't really me who did it.
B. When I accomplish something, I always feel it's me who did it.
8.
A. My body sometimes feels like a stranger to me.
B. My body always feels like me.
10.
A. Sometimes I look into the mirror and see a stranger.
B. When I look into the mirror I see myself.
SELF DETERMINATION SCALE (SDS)
Items Perceived choice
1
A. I always feel like I choose the things I do
B. I sometimes feel that its not really me choosing the things I do
3
A. I choose to do what I have to do
B. I do what I have to, but I dont feel like it is really my choice
5
A. I do what I do because it interests me
B. I do what I do because I have to
7
A. I am free to do whatever I decide to do.
B. What I do is often not what I'd choose to do.
9
A. I feel pretty free to do whatever I choose to.
B. I often do things that I don't choose to do.
Cronbach’s α : >0.80
43. Data source:
• Secondary data: School academic record used to assess the academic
performance of the students in the previous annual examination
44. INTERVENTION
• Intervention module had two parts:
Basic life skills (adapted from intervention module of Adolescent
Girl Empowerment Programme)
Specific health interventions (adapted from existing life skill
education module)
45. Several discussion sessions were held with the respective class teachers
of the selected schools, and priority areas for LSE were identified
From an exhaustive list of identified choices for domains of
intervention, the experts of Community Medicine and experts of
Education identified a limited number of individual empowerment-
specific domains
Intervention module was prepared on the basis of the priorities
46. NIMHANS Module of
LSE : Domains
Motivation
Discipline
Nutrition
Health and
hygiene
Relationship
Social
responsibility
Self-
awareness
Sexuality:
understanding
body and
mind
47. Domains:
Nutrition
• ‘Healthy and unhealthy food’ was renamed as ‘I
decide my food, I decide my health’
• Names of foods were changed based on local food
availability and dietary practices
Health and
hygiene domain
• Intervention related to hand washing was retained
• Goal setting and achieving for increasing the motivation of the
students towards a goal-directed life approach and it was included
from the AGEP module
48. • All the modules, charts and handouts were translated into Bengali
and culturally adapted by bilingual experts
• Sessions ranged from 45 to 120 min
• The intervention was administered by K.S. following training by
A.D. and M.P.S.
• To ensure 100% attendance of the students, attendance was made
compulsory on the intervention days by school authorities
(Details about the intervention was given)
49. DATA COLLECTION
• At baseline, all the students were surveyed by K.S.
• Data regarding primary outcome were obtained from students of the
pretested group only
• All students of the experimental groups were also examined with SDQ
• Data regarding academic performance were obtained for all students at
baseline
50. • Post-intervention data individual resilience, self-determination and
HLC were obtained at 3 months of follow-up from all the four groups
• Data regarding the strength and difficulties of the experimental group
students were obtained at the same time
• Section-wise examination was conducted within the classrooms in
sessions similar to pre-test sessions
(data collection well described)
51. • Bivariate correlations obtained for all independent variables with pre-
test resilience scores
• Standard statistical analysis plan to determine the effect of intervention
and pre-test on primary outcome (Braver and Braver, 1988)
• Multi-level mixed effect general linear modelling
STATISTICALANALYSIS
52. • Random effect of ethnicity nested within each class of study in
addition to considering the fixed effect of ethnicity to obtain an
adjusted effect averaged for the population
• Path analysis performed to determine the direct and indirect effects of
intervention on resilience taking:
Pre-test scores of resilience, internal HLC, self-determination
and intervention as exogenous variables
53. Post-test scores of internal HLC and self-determination as
endogenous variables
Post-test scores of resilience as outcome variables
• Statistical analysis was performed using STATA 13
• Repeated measure ANOVA was performed in SPSS v20
• overall and ethnicity- and sex-stratified marginal means of resilience
before and after intervention (unadjusted and adjusted for baseline
variables) were plotted
(adequate and appropriate)
54. ETHICAL ISSUES
Not well addressed:
• Assent
• Approval from ethics committee
• Registration no. not mentioned
For ethical reasons, all students of each school were included in the
study population
56. Table 1. Comparison of socio-demographic characteristics, family
climate, and academic performance between experimental and control
groups (n = 742)
Variables
Category
or
statisticaa
Experimental
Group
(n=381)n(%)
Control Group
(n=361)n (%)
p
Socio-demographic characteristics
Age (years) Mean (SD) 13.50 (1.53) 13.66 (1.56) 0.15
Sex
Male 239 (62.7) 232 (64.3)
0.67
Female 142 (37.3) 129 (35.7)
a For continuous variables, mean (SD) is reported instead of n (%)
63. Table 2. Comparison between pretested experimental and pretested
control groups at pre-test of resilience, self-determination and internal
HLC score
Variables
Pretested
Experimental
Group
(n =194)a
M (SD)
Pretested
Control Group
(n=181)a
M (SD)
Mean diff.
ΔM
(95% CI)
Resilience Individual
Personal 15.99 (3.11) 15.62 (3.37)
0.37 (-0.28
to 1.03)
Peer 6.32 (1.29) 6.19 (1.38)
0.13 (-0.14
to 0.40)
65. Variables
Pretested
Experimental
Group
(n =194)a
M (SD)
Pretested
Control Group
(n=181)a
M (SD)
Mean diff.
ΔM
(95% CI)
Resilience Caregiver
Physical 7.41 (1.63) 7.17 (1.64)
0.25 (-0.08
to 0.58)
Psycho-
logical
16.71 (4.21) 16.16 (4.08)
0.55 (-0.30
to 1.39)
Total 24.12 (5.76) 23.33 (5.64)
0.79 (-0.37
to 1.95)
Table 2. Cont.
66. Variables
Pretested
Experimental
Group
(n =194)a
M (SD)
Pretested
Control
Group
(n=181)a
M (SD)
Mean diff.
ΔM
(95% CI)
Resilience Context
Spiritual 8.82 (2.07) 8.59 (2.09)
0.23 (-0.19
to 0.65)
Educa-
tional
5.88 (1.54) 5.73 (1.51)
0.15 (-0.16
to 0.46)
Cultural 14.49 (3.30) 14.18 (3.37)
0.41 (-0.26
to 1.09)
Total 29.28 (6.49) 28.50 (6.53)
0.79 (-0.54
to 2.11)
Table 2. Cont.
67. Table 2. Cont.
Variables
Pretested
Experimental
Group
(n =194)a
M (SD)
Pretested
Control
Group
(n=181)a
M (SD)
Mean diff.
ΔM
(95% CI)
Resilience Total score 89.06 (18.11) 86.76 (17.98)
2.31 (-1.36 to
5.97)
Self-
determina-
tion
Perceived Choice 14.63 (3.20) 14.77 (3.20)
0.14 (-0.61 to
0.32)
Awareness of self 14.74 (3.28) 14.79 (3.14)
0.05 (-0.51 to
0.41)
Total 29.37 (6.42) 29.57 (6.27)
0.20 (-1.11 to
0.72)
Internal
HLC
21.22 (4.77) 20.59 (5.28)
0.63 (-0.09 to
1.35)
68. Bivariate correlations:
• At baseline, all exogenous and endogenous variables considered in this
study had statistically significant association with resilience factors,
except type of family and age of students, generally in the expected
directions
• For example, greater levels of violence experienced were associated
with lower resilience
69. Pre-test sensitization:
• In 2-way ANOVA to determine the main effect and interaction effect
of the two factors (i.e., pre-test and intervention), only the intervention
effect was statistically significant on the post-test scores
• Mean difference of estimated marginal means between the intervention
and non-intervention group was 12.86 (p < 0.001)
73. Table 3: Cont.
Variables β (95% CI)
PCI (Ref: <median) 1.19 (-1.49, 3.88)
Standardized academic score
(Ref: <median)
1.26 (-0.36, 2.87)
Substance abuse among parents
(Ref: absent)
-3.26 (-4.31, -2.19)
Violence in the family
(Ref: absent)
-13.22 (-15.78, -10.65)
Physical abuse (Ref: absent) -13.85 (-15.25, -12.45)
Note. Shown are coefficients for fixed-effect parameters. Random-effect parameters
included in the model: Class (ethnicity). PCI and standardized academic score were
dichotomized based on their medians.
74. Effect of ethnicity:
Baseline Resilience
Before adjustment ∆M (tribal – nontribal) -5.48 (-9.50, - 1.46)
After adjustment ∆M (tribal – nontribal) -0.29 (-3.88, 3.31)
After intervention
Before adjustment Resilience Increased both in
tribal and nontribal groups
F(1,373)=326.62;p<0.001
After adjustment F(1,362)=9.86;p=0.005
75. Model Variable β (95% CI) p
Model 1 (outcome:
pre-test resilience score)
Ethnicity (Ref: tribal) 5.55 (1.68, 9.42) <0.005
Model 2 (outcome:
post-test resilience score)
Ethnicity (Ref: tribal)
-1.53 (-3.02, -
0.03)
0.046
Pre-test resiliencea 0.99 (0.95, 1.03) <0.001
a For pre-test resilience, the coefficient β refers to the association or correlation
between pre-test and post-test resilience scores
Table 4. Effect of ethnicity on the impact of health empowerment
intervention on resilience: Results of moderation analysis (n = 375)
76. Intervention
Internal HLC
Self determination
Resilience
Internal HLC
Self determination
Resilience
PosttestPretest
Time
cov=17.57 (14.87 to 20.26)
cov=83.52 (72.59 to 94.44)
cov=59.86(50.92to68.80)
r=0.96 (0.93 to 0.98)
r=0.96 (0.93 to 0.98)
r=0.98 (0.97 to
0.99)
β=1.20 (1.07 to 1.34)
cov= -0.14
(-0.26 to
-0.02)
β=0.03
(0.002 to
0.06)
Fig. 2. Structural equation model showing effects of intervention on resilience, self-determination and internal HLC
* Only significant paths has been shown
77. • In line with the objectives
• Some table column headings missing
• Figures are self explanatory
• Footnotes are given
• All statistical analysis has been done
• Number of participants (n) for intervention and control group given
78. STRENGTHS:
• Solomon's four-group design used to avoid the bias of pre-test
sensitization
• 100% participation rate by the students throughout the intervention
79. LIMITATIONS:
• First stage sampling was limited to only two community development
blocks because of limitation of resources
• Students were allocated to different groups through section-wise
allocation, which was a non-random allocation
80. • Data on family climate-related variables were based on self-reports
of the adolescents, which may be exaggerated/under-reported
• Academic performance of the students was measured using record
of school performance only, which may contain recording errors
(strengths and limitations well addressed)
81. • LSE-based health empowerment intervention successfully increases
resilience and two important resilience characteristics, self-
determination and HLC
• Reduces the gap in resilience between tribal and non-tribal
adolescents
CONCLUSIONS
(conclusions are in line with objectives)
82. RECOMMENDATIONS:
• Quality-assured training of the teachers and quality control of
intervention
• Study informs the existing health policy that school mental health
services should be coupled with developmental activities
• Follow-up study to determine washout period of effect of intervention
(specific, doable but not derived from study findings)
Diff between grp A and grp C post-test allows to check for pretest effect
Diff between grp B and D post-test shows pre-test effect independent of Tt
If d diifers from c , we can conclude pre-test had some effects on the results
Disadv:
More sample
Few investiators interested
More complex
Means exposure to pre-test increases sensitivity to the Tt, thus affecting generalizability from a pretested sample to an unprotested population
Pretest sensitization occurs when part scores on post-test is influenced as a result of pre-test being administered
Adv: 2 extra control grp: control for confounding
Inc external validity coz real life situations by taking post test only as well
Assures equality of grps even in quasi exp
Resilience often mistaken to be trait of individual termed as resiliency
Resilience : bases : self-confidence, self-esteem, self-concept
______________________________________________________________________
3
RESILIENCE
Based on work conducted by researchers affiliated with the Resilience Research Centre, we
now understand resilience ecologically. An ecological perspective implicates those mandated to help
(social workers, child and youth care workers, psychologists, nurses, educators, etc.) as well as
those expected to provide support (communities, family, and peer groups) in the process of
intervening to provide a child opportunities to realize his or her potential.
Resilience is defined as:
I. The capacity of individuals to navigate their way to resources that sustain
well-being;
II. The capacity of individuals’ physical and social ecologies to provide those
resources; and
III. The capacity of individuals, their families and communities to negotiate
culturally meaningful ways for resources to be shared.
Self-determination
indicates the self-control of an individual over his/her behaviour
and health-related actions, and is also related to autonomy in
making the best decision out of available alternatives of behaviour
or action to ensure a rewarding health outcome
HLC:HEALTH EXPECTANCY
‘Adaptive’ means that a person is flexible in approach and is able to adjust to different circumstances.
‘Positive behavior’ means that a person is forward looking and that even in difficult situations he/ she can find a ray of hope and find alternative solutions to problems. In short ‘RESILIENCE’
Life Skills of a person develop over the years continuously in a dynamic manner.
Given desire to do so and scope to do so
Decision Making The process of assessing an issue by considering all possible/available options and the effects those different decisions might have on them.
PROBLEM choosing the one which suits best
Creative Thinking It is an ability that helps us look beyond our direct experience and address issues in a perspective which is different from the obvious or the norm. It adds novelty and flexibility to the situation of our daily life. It contributes to problem solving and decision making by enabling us to explore available alternatives and various consequences of our actions or non-action
Critical Thinking It is the ability to analyze information and experiences in an objective manner.
Critical Thinking It is the ability to analyze information and experiences in an objective manner.
Interpersonal Relationship It is a skill that helps us to understand our relations with relevant others and relate in a positive/reciprocal manner with them.
Self-Awareness This includes our recognition of ourselves, our character, strengths and weaknesses, desires and dislikes
Empathy It is an ability to imagine what life is like for another person even in a situation that we may not be familiar with
Coping with Emotions It is an ability, which involves recognizing emotions in others and ourselves, being aware of how emotions influence behavior and being able to respond to emotions appropriately.
Coping with Stress It an ability to recognize the source of stress in our lives, its effect on us and acting in ways that help to control our levels of stress
a process through which people gain greater control over decisions and actions affecting their health
aim of empowering patients is to help them develop self-awareness, self-care and promote the understanding that patients can be equal partners in their healthcare decisions
empowerment puts patients at the heart of health services so that they are able to derive the maximum benefits from it
INDIA HOME TO 253 MIL ADOL (2011) – 21%
WEST BENGAL ; 7% (18 MIL ) AND MANIPUR : 2% (6 LAKHS)
Some adolescents are at greater risk of mental health conditions due to their living conditions, stigma, discrimination or exclusion, or lack of access to quality support and services. These include adolescents living in humanitarian and fragile settings; adolescents with chronic illness, autism spectrum disorder, an intellectual disability or other neurological condition; pregnant adolescents, adolescent parents, or those in early and/or forced marriages; orphans; and adolescents from minority ethnic or sexual backgrounds or other discriminated groups
. Mental health conditions account for 16 percent of the global burden of disease and injury in people aged 10-19 years, half of which starts by 14 years of age
National Mental Health Survey 2015-16, prevalence of mental disorders in age group13-17 years was 7.3% and nearly equal in both genders
INDIA: 104 MIL TRIBAL ( 8-6%) ,705 TRIBES [ MAN: 35.1%, WB : 5.1% ]
90% RESIDES IN RURAL AREAS
capacity building is defined as the "process of developing and strengthening the skills, instincts, abilities, processes and resources that organizations and communities need to survive, adapt, and thrive in the fast-changing world
SSDL: STAGED SELF DIRECTED LEARNING MODEL
the extent
to which the critical components of an intended program are present
when that program is enacted
POP; 29 LAKH ( 87% RURAL AND 13% URBAN
focused on Sabar & Bihore community in 10 selected Blocks in Purulia – Baghmundi, Balarampur, Jhalda, Bandwan, Barabazar, Manbazar-II, Manbazar-I, Hura, Puncha, Purulia-I. These 10 Blocks chattered services in 171 villages in 51 Sub-Centre area.Focus :-
Provide integrated and quality public health care service.
Assess the unmet needs of RCH services in different tribal communities.
Promote community participation and intersectoral co-ordination.
Develop 1st referral services and tackling emergencies.
Training of the local tribal persons/TBAs to act as link volunteers in the block / SC areas
Voucher Scheme
Aayushmati sceme
Bed nets
TOTAL ADOLESCENT POPULATION IN EACH DISTRICT
Distance between the schools: contaimination bias
Total no. of schools of purulia district ( private, gvt, co-ed)
No need to mention for tribal project of 2007
PURULIA ( 1.5 LAKH ) > BALA(1.37 LAKH)
LTERACY RATE WB : 76.3 , PURU: 64.5
TRIBAL POP PURULIA : 5 LAKHS- 20.8% [ PUR I 8.70% AND BAL: 37.32%]
Students of class X and XII were not available because of different examinations including board examinations.
Class XI students were not included because most of these students were newly admitted in the schools following secondary examination.
Not explained how they elected randomly the blocks
Purulia total schools: 156, co-ed: 116
What plan? Int given: 381 , not: 361
Total pre-testes: 368
Not :374
POP COUNCIL AGEP:
TypeNGOPurposeReproductive healthHeadquartersNew York City, USAFounder
John D. Rockefeller III
Population Council conducts research to address critical health and development issues
eAdolescent Girls Empowerment Programme (AGEP) was a social, health, and economic asset-building programme targeting vulnerable adolescent girls aged 10–19. AGEP was implemented at 10 sites in four of the 10 provinces of Zambia( late 2013 to early 2016.)
Over 240 mentors in AGEP guided 11,390 adolescent girls aged 10–19 at baseline into the programme and through a planned two years of programming, accumulating to approximately 40,884 meetings
Refreshment breaks were available for longer sessions
to determine the effects of intervention on resilience after adjusting for the effects of all baseline variables
that had statistically significant association
Multilevel: flexible approach for correlated data
with resilience
GLM : supports analysis of continuous dependent variable for random effects, repeated measures, hierarchical effects
Clusters
Repeated measurements
Multiple related outcome measures taken at one pt of time
- In these situations mixed model allows wide variety of correlation patterns
manual labor such as packager, assembler, or apprentice, or farm worker. Unskilled jobs usually do not require formal education and can be performed by the majority of individuals.
proper discharge of duties assigned to him or relatively narrow job and where important decisions made by others. His work is thus limited to the performance of routine operations of limited scope.
skilled employee is one who is capable of working efficiently of exercising considerable independent judgement and of discharging his duties with responsibility
For internal HLC and self-determination, experimental group n ¼ 381, control group n ¼ 361.
which is 14.54% higher resilience among intervention
group students than non-intervention group students
THEY said in text tribal ethnicity had large negative effect on resilience.. Here ethnicity is not explained
Median:?
Mean:
while resiliencewas less among tribal adolescents
than non-tribal adolescents at baseline, improvement in resilience
after intervention was more among tribal adolescents. This finding
supports the perspective that broad social/environmental conditions
or context plays a very important role in the resilience process
No missing data
developed by combining generic life skills and health specific
interventions along with cultural adaptation
developed by combining generic life skills and health specific
interventions along with cultural adaptation
These developmental activities
include improvement in adult education and a comprehensive
family climate improvement programme for tribal families to
nullify the gap in resilience between tribal and non-tribal adolescents
in tribal areas